Suprachoroidal Injection of Triamcinolone Acetonide: Advancing Treatment for Resistant Diabetic Macular Edema

Purpose:  To evaluate the effectiveness and safety of suprachoroidal triamcinolone acetonide (SCTA) in managing treatment-resistant diabetic macular edema (DME) over a 6-month period. Study Design:  Interventional case series. Place and Duration of Study:  Benazir Bhutto Hospital, Rawalpindi Medical University from June 2023 to May 2024. Methods:  A total of 64 phakic eyes with refractory DME were included. All eyes received a single SCTA injection (4 mg in 0.1 ml).Re-injection if needed was given after 3 months.Central subfield thickness (CST), best-corrected visual acuity (BCVA), and intraocular pressure were measured at baseline, 1st, 3rd, and 6th month post-injection. Analysis was performed using paired t-test and repeated measures ANOVA in SPSS version 27, with p value< 0.05 considered significant. Results:  The mean baseline BCVA was 0.800±0.16LogMAR, improving to 0.709, 0.386, and 0.480 at 1st, 3rd and 6th month respectively after injection (p=0.000). The mean baseline CST was 685.20±133.21, which significantly reduced to 308µm at 1st month, 298.78 µm, and 346.91 µm at 3rd and 6th month respectively (p=0.000). There was no statistically significant difference in IOP and cataract grading 6th month after SCTA. A re-injection was required in 28.1% of patients after 3 months, with no major complications observed. Conclusion:  Suprachoroidal triamcinolone acetonide is an effective and safe therapy, resulting in both anatomical and functional improvement in patients with resistant diabetic macular edema for up to 6 months.It is advisable that SCTA be utilized with caution by skilled surgeons when treating resistant DME.